重叠综合征患者肺动脉压力与血管内皮功能的研究

目的:探讨重叠综合征(OS)患者肺功能、睡眠呼吸参数和肺动脉压力的变化以及肺动脉压力与血管内皮功能的相关性。方法:收集2009年2月至2012年1月我院呼吸科诊断的慢性阻塞性肺疾病(COPD)、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和OS患者各60例,分别测定患者肺功能、睡眠呼吸参数、平均肺动脉压力(mPAP)、血清内皮素1(ET-1)、一氧化氮(NO)和血管内皮生长因子(VEGF)水平。结果:OS组与单纯COPD组和OSAHS组相比,第1秒用力呼气容积(FEV1)(%预测值)、FEV1/用力肺活量(FVC)和快速眼动相睡眠(REM)占总睡眠时间百分比(%)均明显降低(P<0.05);而睡眠呼吸暂停低通气指数(AHI)、Epworth嗜睡量表(ESS)评分和mPAP明显增高(P<0.05);OS患者血清中ET-1和VEGF浓度明显高于单纯COPD和单纯OSAHS患者(P<0.05),并与其mPAP呈正相关,而NO浓度显著降低,与mPAP呈负相关。结论:OS患者较单纯的COPD和OSAHS患者更易合并肺动脉高压,外周血ET-1、VEGF和NO的浓度与肺动脉压力有一定的相关性。

Pulmonary arterial pressure and vascular endothelial function in patients with overlap syndrome

Objective To explore the changes of pulmonary function and sleep respiratory parameters,and to analyze the correlation between mean pulmonary arterial pressure(mPAP) and vascular endothelial function in patients with overlap syndrome(OS).Methods Sixty OS patients,60 chronic obstructive pulmonary disease(COPD) patients and 60 obstructive sleep apnea and hyperpnoea syndrome(OSAHS) patients from Feb 2009 to Jan 2012 were enrolled in this study.Pulmonary function,sleep respiratory parameter,mPAP,endothelin-1(ET-1),nitric oxide(NO) and vascular endothelial growth factor(VEGF) were assessed and analyzed.Results Forced expiaratory volume in 1 s(FEV1)(% predicted value),FEV1/ forced vital capacity(FVC) and rapid eye movement sleep(REM) % were significantly lower in OS patients than those in COPD and OSAHS patients(P<0.05),while apnea hypopnea index(AHI),Epworth sleepiness scale(ESS) and mPAP were significantly higher in OS patients than that in patients with COPD and OSAHS(P<0.05).Serum levels of ET-1 and VEGF were significantly higher in OS patients than that in COPD and OSAHS patients(P<0.05) and was positively correlated with mPAP.However,NO level was significantly lower in OS patients(P<0.05) and was negatively correlated with mPAP.Conclusions Pulmonary hypertension was significantly more common in OS patients than in COPD and OSAHS patients,and a correlation was found between pulmonary arterial pressure and levels of ET-1,VEGF and NO.